NHS IT programme refuses to die

Nine years after its launch, the £11.4bn National Programme for IT (NPfIT) is to be scrapped. The House of Commons Public Accounts Committee, the National Audit Office and the Major Projects Authority have all reached the conclusion that this project has failed to deliver on its promises, and will probably never do so. Even one of the main supplier’s own shareholders are mounting a class action citing that the company, CSC, is ‘incapable’ of delivering this project. Faced with this sustained criticism, it would be hard for any government to do nothing. Accordingly, an announcement was made on September 18 that NPfIT has been scrapped and the management of NHS IT will be restructured in an as-yet unspecified way. This has been presented (via a Daily Mail leak) to the tax-paying public as a positive decision with two headline benefits: firstly, an implied saving on the £12bn price tag; secondly, a move to the devolved free?market decision-making beloved of this government. The rationalisation of an inevitable announcement looks nakedly political. The facts show this programme has been out of control for years. In its long history, the programme has seen drop-outs of both supplier and participating early adopters’ client sites as well as ongoing contract litigation. The stream of reports simply confirms NPfIT is a textbook example of an IT mega-project that got out of control. Inadequately specified, poorly managed and seemingly the subject of weak cost control. ComputerWorld UK blogger Tony Collins believes killing the project will not deliver savings either. He points out that the easy stuff has already been done. The previous government reacted to rampant stakeholder discontent by relaxing some of the requirements for local trusts to use the technology. Tweaks to contracts have only clawed back small amounts. However, Collins suggests, NHS trusts will continue to be obliged to buy a majority of the same services and products from erstwhile NPfIT suppliers (BT and CSC), or face being hit with punitive contract penalties. The new freedom to source at NHS Trust level may prove largely illusory. In which case what, exactly, has changed? The justification for scrapping the entire scheme is that the NHS is no longer needs one-size-fits-all solutions. CSC’s Lorenzo, part of the project that brought the whole edifice toppling down, was focused on making patient record data interoperable between different functions of the NHS and between local health authorities. But everyone, including CSC’s own investors, is now saying this is impossible. So is this functionality no longer required? The hope is that smart CIOs in local health authorities can expand upon this need for interoperability through their own IT operations and though working with each other directly. Whether the scrapping of NPfIT will allow them to walk away from discredited, centralised solutions in favour of the cheaper, more flexible ones they crave is less clear.

Timeline of NHS IT failure

2002 Programme launched 2004 Original delivery date for CSC’s Lorenzo Care records system 2006 Two open letters to the Health Select Committee from IT academics raise concerns about the project 2007 Kings Fund report criticises NPfIT project audit and evaluation procedures May 2008 Fujitsu contract terminated 2009 31 Internal Gateway reviews reveal  ongoing and long-standing doubts about suppliers and value for money. Public Accounts Committee highlights unaddressed deployment risks September 2011 NPfIT ‘scrapped’. US investors launch class action against CSC